Surgery Best for Carpal Tunnel Syndrome

THURSDAY Sept. 24, 2009 -- Surgery is slightly better than non-surgical treatment for patients with carpal tunnel syndrome who don't have severe nerve damage (denervation), new research has found.

The study included 44 patients who had surgery and 52 patients who had non-surgical treatment, such as hand therapy and ultrasound. A year after treatment, the patients' hand function was measured using the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ).

The patients who had surgery showed an advantage in both function and symptoms -- calculated by proportions of patients having at least 30 percent improvement in CTSAQ scores for these indicators, and having minimal interference in daily work or household activities. The study found that 46 percent of surgery patients and 27 percent of non-surgery patients met all three criteria.

"Overall, these data indicate that, in patients with carpal tunnel syndrome without denervation, surgery modestly improves hand function and symptoms by three months compared with a multimodality non-surgical treatment regimen, and this benefit is sustained through one year," wrote Dr. Jeffrey Jarvik, of Harborview Medical Center at the University of Washington in Seattle, and colleagues.

The study appears online Sept. 24 in a special surgery issue of The Lancet.

Patient treatment preference is an important factor, two Swedish doctors noted in an accompanying editorial. When patients are "faced with the need to wear a splint each night and during daytime for some weeks, some might prefer early surgery while others may prefer partial recovery to potential surgical risk," wrote Dr. Isam Atroshi and Christina Gummesson, both of Lund University.

"Nevertheless, patients with carpal tunnel syndrome who do not have satisfactory improvement with non-surgical treatment should be offered surgery," the editorialists concluded.

Another study in the special surgery issue of The Lancet found that placing a drain in the skull after surgery reduces the risk of death and recurrence among patients with chronic subdural hematoma, in which blood collects under the dura, the outer protective membrane that covers the brain.

After surgery to drain the blood, between 5 percent and 30 percent of patients have recurrence of chronic subdural hematoma and require redrainage, Peter Hutchinson of Addenbrooke's Hospital in Cambridge, U.K., and colleagues noted.

In the study, the researchers assessed 215 patients, aged 18 years and older, with a chronic subdural hematoma who were treated using the burr-hole surgery technique. Of those patients, 108 had a plastic drain inserted a few centimeters into the subdural space after surgery. The drain was left in for a few days.

Subdural hematoma recurred in 10 of 108 people (9.3 percent) with the drain and in 26 of 107 (24 percent) of patients without the drain. After six months, 8.6 percent of patients in the drain group and 18.1 of those in the non-drain group had died, the researchers reported.

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